It Finally Looks Like the Politicians Are Paying Attention to Medicare, Like It or Not

While healthcare reform is now 13 months old, one might have been misled into believing the country had solved the health care crisis. Sure, many more Americans will have access to affordable healthcare insurance. Health care reform, or health care insurance reform as many call it, is a big step forward for so many Americans who have been denied access to the health care system for a whole host of reasons.

It, almost, does not matter that many of the key provisions do not kick in for several years. We heard about some of the quick "wins" now in effect. Children under age 26 are allowed to stay on their parents insurance (in most cases); lifetime caps on insurance coverage have been removed; Medicare beneficiaries have seen the donut whole start to close and get some "free" preventative services. I could list many more but that is not the point.

A significant proposal was introduced for controlling the skyrocketing costs of Medicare, an increasingly difficult financial burden for the federal government. The House Budget Committee Chairman, Paul Ryan, a Republican, presented a comprehensive budget proposal that includes a plan to privatize Medicare. Representative Ryan believes his plan will save the federal government billions of dollars annually and prevent insolvency of the Medicare program.

It is important to understand Medicare is, generally speaking, supported by health care taxes (paid by us), premiums paid by beneficiaries for certain components of the program (physicians and drugs), and by general funds from the federal budget (income taxes paid by us). This plan assumes the private sector will do a better job reigning in the skyrocketing costs of Medicare than the federal government can do on its own. The sad truth is Representative Ryan may be right but I hope he's wrong.

I am a supporter of the Patient Protection and Affordable Care Act. I have made no secret in telling people the current system is severely broken and on a path to financial ruin. I have also said the health care reform law is flawed and does not go far enough in addressing the skyrocketing costs of providing health care to Medicare beneficiaries and all Americans. We are faced with some very simple facts:

  1. Our population is aging and will increasingly need access to health care services;
  2. The costs of providing these health care services will only continue to rise as new and more expensive treatments are developed each and every day as we try to lead the world in new and innovative scientific discovery;
  3. There is no limit in our nations appetite for the best health care services money can buy;
  4. We will not accept any rationing of services, treatments or a system that denies us access to health care on demand.

The health care reform law creates new agencies and models for addressing our inefficient and piecemeal system of providing care. There will be new payment mechanisms that reward providers for better outcomes in addition to financial incentives for lowering costs. While most of these details have yet to be written and will undoubtedly be confusing to many, I believe it is a sincere attempt at starting to look at how we can deliver better and more cost effective care. Unfortunately, I do not think it is enough.

Our elected leaders have let us down. Republicans and Democrats. They have failed to articulate a clear path towards a stable health care system that our country can afford. They are ignoring the simple facts above. Both parties, for political reasons, appear to be unwilling to be honest with the voters. They refuse to say the obvious which is: our country cannot afford what we have today unless we are willing to pay more for our health care with higher taxes/higher premiums or, we are going to have to learn to live with less.

This is America, we do not like living with less and no one wants to pay more for anything. While there is dispute over whether we can even afford the health care reform that was passed, and we will not know the real answer until the program is up and running in 2014. We do know that Medicare costs (and health care in general) will continue to rise at a rapid rate and far outstrip any savings the government can get out of the Medicare program through these new, yet to be defined initiatives.

While we needed to start somewhere with health care reform, we all quickly became disinterested in the looming health care financing crisis. It is naïve to think this whole mess will work itself out on its own. It will not and we will unquestionably be forced to address the health care cost problem down the road. And this is where Representative Ryan took a shot at something new. He seems to believe the private sector can handle the harsh and strong criticisms that would undoubtedly come from privatizing Medicare by changing the benefits and cost structure of the current system for seniors. He believes Congress will not make the difficult choices that need to be made. Instead, the proposal he offers will do the same thing Congress would need to do but shift the burden to the private sector.

Wealthier seniors would pay higher premiums, have higher deductibles/co-insurance, and all may have less access and choice than they have today. Some services may not even be covered. If the government were to step in and regulate the private sector and force them to provide the same benefits at the same price, then there would be no savings to the Medicare program. It would have to change for the Ryan plan to work. In the end, the voters are going to have to decide. But in making this decision, the voters need to understand the real problem and be willing to accept the changes that are necessary. This is not about death panels. This is about understanding how our health care system has changed since Medicare was first created. Back then, we did not live as long and we did not have access to all the wonderful treatments we have today.

I for one do not want to live with less. I love the innovation that comes from our medical schools, teaching hospitals, and laboratories. But I also realize we will have to pay more for it to continue. To rely on simple "cost saving initiatives" is not enough and will not solve this problem. Shifting the burden onto the private sector does not change the fundamental issues we are confronting today. It merely places private sector in awkward position of solving a problem they did not create and one we refused to deal with on our own.